While any older adult could be a victim of elder abuse, people with mental health issues are at a greatly increased risk of being victimized. Approximately 6 million to 8 million Americans 65 years of age or older have mental health or substance-use disorders, and the Institute of Medicine (IOM) estimates that their numbers will reach 10.1 million to 14.4 million by 2030. Many of these older adults experience ongoing or late onset periods of depression, anxiety, impaired cognition, substance abuse, and other psychiatric conditions. Conditions such as these, left untreated, can lead to an increased dependence or reliance on others which can increase an older adult’s vulnerability to abuse. It can also lead to or exacerbate self neglecting behaviors which often jeopardize an elder’s health status, housing, and income stability.
So many of our elderly clients at Greater Boston Legal Services suffer from mental illness which is often untreated, undiagnosed, and unacknowledged. Most encounter significant barriers to asking for or receiving mental health services including physical frailty, mobility issues, lack of transportation or money, lack of linguistically or culturally appropriate providers, lack of family or community support, and an inability to self-refer for treatment. As a result many elders experience avoidable hospitalizations and/or premature or inappropriate placement in nursing homes. These results are costly – both for the elder who may end up in a facility that is not well-suited to address his mental health issues, and for taxpayers, as the health care and long-term care systems are considerably more expensive than community-based care. A major key to elder abuse prevention is the provision of geriatric mental health services that meet people where they live. These services need to be provided in the most comfortable and accessible settings, including in elders’ homes. Wraparound services, such as intensive case management and supports to maintain tenancy, should be provided to those who need it. Services must be culturally competent and linguistically appropriate as well.
Our emerging demographics and the prevalence of mental illness among older adults requires a shift in the delivery paradigm for geriatric mental health care. In Massachusetts, a group of advocates from the Massachusetts Aging and Mental Health Coalition,(MAMHC) of which our Elder Abuse Prevention Project is a member, are trying to do just that. Massachusetts received approximately $110 million in federal funds from the Balancing Incentive Program. We have crafted a plan that would allow some of these funds to transform the geriatric mental health delivery system across the state to deliver the type of in-home mental health counseling and services that we know actually works. We have seen this model work effectively in communities that already deliver accessible mental health services. The results in these communities are overwhelmingly positive – allowing elders to remain in their homes and out of unsafe, inappropriate and expensive settings such as homeless shelters, hospitals, and nursing homes. The cost savings are significant, but more importantly, the increase in an older adults’ quality of life is priceless. Stay tuned as our MAMHC coalition continues to advocate on this critically important issue.
 The Underside of the Silver Tsunami – Older Adults and Mental Health Care: Stephen J. Bartels, M.D. and John A Naslund, M.P.H. N.Engl.J.Med, 2013